Most people pay out of pocket for private duty in-home care.  Unfortunately, many government-sponsored programs have inadequate funding and although seniors may qualify, shifts regularly go unfilled.  Mary Poppins is not showing up at your house under one of these scenarios.  Medicaid programs are forced to hire anyone with a pulse because there is so much demand and so few are willing to work in the thankless environments they are placed in.  Although more costly, hiring a local private duty agency is a good option to receive professional care on a consistent basis.